Provider Demographics
NPI:1760800528
Name:GORMAN FRAZIER, CARLA (NP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:GORMAN FRAZIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1555 NE RICE RD # C
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5849
Mailing Address - Country:US
Mailing Address - Phone:816-966-0900
Mailing Address - Fax:
Practice Address - Street 1:1555 NE RICE RD # C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5849
Practice Address - Country:US
Practice Address - Phone:816-966-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009954363LP0808X
KS76222363LF0000X
MO2014000944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily